2003-09-05_REPORT - M1980110

• Permit No: M1980110
• IBM Index Class Name: Report
• Doc Date: 9/5/2003
• Doc Name: Annual Fee/Report/Map
• Permit Index Doc Type: Annual Fee / Report
• Media Type: D
• Archive: No

r/
PERMITTEE NAME:
PERMIT NO.:
OPERATION NAME:
ANNIVERSARY DATE:
ANNUAL FEE DUE:
COUNTY:
E-470 Public Highway Authority
M-1980-110
Henderson Development
September 9, 2003
$688.00 (Due on or before your anniversary date)
Adams
RECEIVEp
SEP 0 52003
Division of Minerals and Geology
According to C.R.S. 3432.5-116 or C.R.S. 34-32-116, each year, on the anniversary date of the permit, an operator
shall-submit-the-annual-fee; a-report and map-showing the-extent-of-current-disturbances-to affected-land,-- --
reclamation accomplished to date and during the preceding year, new disturbances that are anticipated to occur
during the upcoming year, reclamation that will be performed during the coming year, the dates for the beginning
of active operations, and the date active operations ceased for the year, if any.
Please attach y~onr revised written annual report and anneal re~nrt mgp.,tn this form. Please note that an
adequately labeled map that clearly delineates and includes the above elements may suffice for a written report.
Division records indicate the following permittee contact information. Please verify and make any necessary
changes:
Permittee Contact: -° ""~-,o-z.~.'- °',,.~re~i~a-
Permittee Name: E-470 Public Highway Authority
Matz- /}t..EXar~t~
Address: 22470 E. 6th Pkwy
Aurora, CO 80018
Phone Number: [phone]
Fax Number:
(3D3~ 537 -34'12
If you have additional comments and/or information that should be provided to the Division, please provide it
below or attach it to this form along with your written report and map. Annua] Report instructions are enclosed.
ignature of Corporate Officer, Owner, or Designee
91~~b 3
Date
M:~PERM ITUTASTERDOCUM ENTSUI-AF-01